<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('修改就诊信息')" />
</head>
<body class="white-bg">
    <div class="wrapper wrapper-content animated fadeInRight ibox-content">
        <form class="form-horizontal m" id="form-visit-edit" th:object="${tableVisit}">
            <input name="id" th:field="*{id}" type="hidden">
            <div class="form-group">    
                <label class="col-sm-3 control-label">索引：</label>
                <div class="col-sm-8">
                    <input name="suoying" th:field="*{suoying}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">病历编号：</label>
                <div class="col-sm-8">
                    <input name="binglibh" th:field="*{binglibh}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">用户名：</label>
                <div class="col-sm-8">
                    <input name="username" th:field="*{username}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">姓名：</label>
                <div class="col-sm-8">
                    <input name="name" th:field="*{name}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">手机：</label>
                <div class="col-sm-8">
                    <input name="phone" th:field="*{phone}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">医生建议：</label>
                <div class="col-sm-8">
                    <textarea name="suggestion" class="form-control">[[*{suggestion}]]</textarea>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">缴费金额：</label>
                <div class="col-sm-8">
                    <input name="jiaofeiDoller" th:field="*{jiaofeiDoller}" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">缴费内容：</label>
                <div class="col-sm-8">
                    <textarea name="jiaofeiContent" class="form-control">[[*{jiaofeiContent}]]</textarea>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">医生工号：</label>
                <div class="col-sm-8">
                    <input name="doctorNum" th:field="*{doctorNum}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">医生姓名：</label>
                <div class="col-sm-8">
                    <input name="doctorName" th:field="*{doctorName}" class="form-control" type="text" readonly>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">科室名称：</label>
                <div class="col-sm-8">
                    <select name="doctorKeshi" class="form-control m-b" th:with="type=${@dict.getType('sys_keshi')}" readonly>
                        <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}" th:field="*{doctorKeshi}"></option>
                    </select>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">是否支付：</label>
                <div class="col-sm-8">
                    <select name="payFlag" class="form-control m-b" th:with="type=${@dict.getType('sys_zhifu_flag')}">
                        <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}" th:field="*{payFlag}"></option>
                    </select>
                </div>
            </div>
        </form>
    </div>
    <th:block th:include="include :: footer" />
    <script th:inline="javascript">
        var prefix = ctx + "system/visit";
        $("#form-visit-edit").validate({
            focusCleanup: true
        });

        function submitHandler() {
            if ($.validate.form()) {
                $.operate.save(prefix + "/edit", $('#form-visit-edit').serialize());
            }
        }
    </script>
</body>
</html>